Esports medicine and performance remains a novel research field. One of the earliest papers that proposed a holistic model of support for esports competitors was published by Dr. DiFrancisco-Donoghue and colleagues, and many subsequent papers have built further on their research to develop the field further. 

The article discusses the growing popularity of esports and the need for healthcare professionals to understand the physical and mental health demands and injury management of esport players. Colleges, universities, and high schools are adding esport teams at a rapid pace. Researchers state that while there has been a degree of debate about whether or not esports are “real sports” and whether or not esports athletes are “real athletes”, esports teams are the ‘new athletes’ on campus and should be held to the same standards as other athletes with regards to health, game-specific fitness, and performance. The researchers also point out that esport players suffer health concerns and chronic overuse injuries such as wrist and hand injuries–meaning that regardless of the “realness” of their sport, they have considerations that require the support of medical and performance specialists.

Data was collected from a survey of 65 collegiate varsity esport players between the ages of 18-22 years from eight different universities in the USA. The data was collected using an anonymous, self-reported electronic questionnaire that was developed by a collaborative effort of the esport players on the New York Institute of Technology campus based on common injuries they have encountered in the past. The survey was designed to identify lifestyle behaviors of esports players in order for the researchers to make suggestions regarding appropriate health and performance infrastructure for esports.

The results of the survey indicated that the average esport player practices between 5.5 and 10 hours a day prior to competitions. Researchers also found the following:

• 15% of the players reported sitting and playing for 3 hours or more without standing to take a break
• 40% of the players reported not participating in any kind of physical activity
• The most common complaints were eye fatigue, back and neck pain, followed by wrist and hand pain
• Only 2% of the athletes surveyed who suffered from pain or injury sought medical attention

The researchers noted that the injuries seen in esports are similar to conditions seen in sedentary desk jobs, and used the term “exercise deficit disorder” to describe reduced levels of physical activity that are not compliant with current public health recommendations. Exercise deficit disorder is defined as having less than 60 minutes of physical activity per day, and 40% of the subjects met the qualifications for this disorder. 

The psychosocial components seen in esport can include addictive behavior, personal hygiene issues, social anxiety, and sleep disturbances, and are associated with mental and health disorders. WHO has included gaming disorder in its 11th Revision of the International Classification of Diseases stating that gaming disorder is characterized by impaired control over gaming, increasing priority given to gaming over other activities, continuation or escalation of gaming despite the occurrence of negative consequences.

Researchers suggest that integrating health professionals for the esport athlete is necessary, a plan of services should include baseline testing, clinical evaluations, and services as well as physical and mental health assessments. A healthcare team should have two aims: integrating health management and understanding the demands needed to improve esports skills. 

The head coach has the performance expertise to manage performance, game plan, and sport-specific strength and conditioning goals. The health professionals will have to find a delicate balance of incorporating expertise in physical and mental well-being interspersed in this training protocol. The article also states that esport has not yet been recognized by the National Collegiate Athletic Association and esport teams are usually self-funded, which limits the resources available for medical staff and facilities.

Esport players face challenges in improving performance while minimizing adverse effects to their health. The NCAA does not recognize any esport title as a sanctioned sport; therefore, there are no management protocols for health or injury required for these teams yet. The authors suggest that esport players should be mandated by academic institutions and athletic departments to undergo a health evaluation annually to help prevent injury and to be screened for medical issues, similar to other traditional collegiate and high school sports. 

Some major takeaways from this article include. 

• Esport players are at risk of developing physical and mental health issues similar to those seen in sedentary office workers, such as eye fatigue, back and neck pain, and wrist and hand pain.

• Esport players may not be engaging in enough physical activity, with over 40% of surveyed players having less than 60 minutes of physical activity a day.

• Esport players may be at risk of developing addictive behaviors, personal hygiene issues, social anxiety, and sleep disturbances.

• Esport players may not be reporting their conditions or lack of activity in order to minimize time away from gaming.

• The NCAA does not currently recognize esport as a sanctioned sport, and esport teams are usually self-funded, which limits the resources available for medical staff and facilities.

• To address these issues, esport players should be mandated by academic institutions and athletic departments to undergo a health evaluation annually to help prevent injury and to be screened for medical issues, similar to other traditional collegiate and high school sports.

• Clinicians may encounter resistance from esport players and coaches, and may need to work to establish trust and build a relationship with the team.

Source:

DiFrancisco-Donoghue J, Balentine J, Schmidt G, et al

Managing the health of the eSport athlete: an integrated health management model

BMJ Open Sport & Exercise Medicine 2019;5:e000467. doi: 10.1136/bmjsem-2018-000467

https://bmjopensem.bmj.com/content/5/1/e000467